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Rohde S, Miera O, Sliwka J, Sandica E, Amodeo A, Veen K, de By TMMH, Bogers AJJC, Schweiger M. Durable left ventricular assist device explantation following recovery in paediatric patients: Determinants and outcome after explantation. Eur J Cardiothorac Surg 2024; 65:ezae126. [PMID: 38613845 DOI: 10.1093/ejcts/ezae126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/31/2024] [Accepted: 04/11/2024] [Indexed: 04/15/2024] Open
Abstract
OBJECTIVES Myocardial recovery in children supported by a durable left ventricular assist device is a rare, but highly desirable outcome because it could potentially eliminate the need for a cardiac transplant and the lifelong need for immunosuppressant therapy and the risk of complications. However, experience with this specific outcome is extremely limited. METHODS All patients < 19 years old supported by a durable left ventricular assist device from the European Registry for Patients with Mechanical Circulatory Support database were included. Participating centres were approached for additional follow-up data after explantation. Associated factors for explantation due to myocardial recovery were explored using Cox proportional hazard models. RESULTS The incidence of recovery in children supported by a durable left ventricular assist device was 11.7% (52/445; median duration of support, 122.0 days). Multivariable analyses showed body surface area (hazard ratio 0.229; confidence interval 0.093-0.565; P = 0.001) and a primary diagnosis of myocarditis (hazard ratio 4.597; confidence interval 2.545-8.303; P < 0.001) to be associated with recovery. Left ventricular end-diastolic diameter in children with myocarditis was not associated with recovery. Follow-up after recovery was obtained for 46 patients (88.5%). Sustained myocardial recovery was reported in 33/46 (71.7%) at the end of the follow-up period (28/33; >2 year). Transplants were performed in 6/46 (11.4%) (in 5 after a ventricular assist device was reimplanted). Death occurred in 7/46 (15.2%). CONCLUSIONS Myocardial recovery occurs in a substantial portion of paediatric patients supported with durable left ventricular assist devices, and sustainable recovery is seen in around three-quarters of them. Even children with severely dilated ventricles due to myocarditis can show recovery. Clinicians should be attentive to (developing) myocardial recovery. These results can be used to develop internationally approved paediatric weaning guidelines.
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Affiliation(s)
- Sofie Rohde
- Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Oliver Miera
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Joanna Sliwka
- Department of Cardiac Surgery, Transplantology and Vascular Surgery, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Eugen Sandica
- Clinic for Pediatric Cardiac Surgery and Congenital Heart Defects, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Antonio Amodeo
- Heart Failure, Transplant and MCS Unit, Bambino Gesù Children Hospital & Research Institute, Rome, Italy, Catholic University of Sacred Heart, Department of Cardiac Surgery, Rome, Italy
| | - Kevin Veen
- Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Ad J J C Bogers
- Department of Cardio-thoracic surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Martin Schweiger
- Children's Hospital Zurich, Pediatric Heart Centre, Department for congenital heart surgery, Zurich, Switzerland
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2
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Nicin L, Abplanalp WT, Schänzer A, Sprengel A, John D, Mellentin H, Tombor L, Keuper M, Ullrich E, Klingel K, Dettmeyer RB, Hoffmann J, Akintuerk H, Jux C, Schranz D, Zeiher AM, Rupp S, Dimmeler S. Single Nuclei Sequencing Reveals Novel Insights Into the Regulation of Cellular Signatures in Children With Dilated Cardiomyopathy. Circulation 2021; 143:1704-1719. [PMID: 33618539 DOI: 10.1161/circulationaha.120.051391] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) is a leading cause of death in children with heart failure. The outcome of pediatric heart failure treatment is inconsistent, and large cohort studies are lacking. Progress may be achieved through personalized therapy that takes age- and disease-related pathophysiology, pathology, and molecular fingerprints into account. We present single nuclei RNA sequencing from pediatric patients with DCM as the next step in identifying cellular signatures. METHODS We performed single nuclei RNA sequencing with heart tissues from 6 children with DCM with an age of 0.5, 0.75, 5, 6, 12, and 13 years. Unsupervised clustering of 18 211 nuclei led to the identification of 14 distinct clusters with 6 major cell types. RESULTS The number of nuclei in fibroblast clusters increased with age in patients with DCM, a finding that was confirmed by histological analysis and was consistent with an age-related increase in cardiac fibrosis quantified by cardiac magnetic resonance imaging. Fibroblasts of patients with DCM >6 years of age showed a profoundly altered gene expression pattern with enrichment of genes encoding fibrillary collagens, modulation of proteoglycans, switch in thrombospondin isoforms, and signatures of fibroblast activation. In addition, a population of cardiomyocytes with a high proregenerative profile was identified in infant patients with DCM but was absent in children >6 years of age. This cluster showed high expression of cell cycle activators such as cyclin D family members, increased glycolytic metabolism and antioxidative genes, and alterations in ß-adrenergic signaling genes. CONCLUSIONS Novel insights into the cellular transcriptomes of hearts from pediatric patients with DCM provide remarkable age-dependent changes in the expression patterns of fibroblast and cardiomyocyte genes with less fibrotic but enriched proregenerative signatures in infants.
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Affiliation(s)
- Luka Nicin
- Institute for Cardiovascular Regeneration (L.N., W.T.A., D.J., H.M., L.T., S.D.), Goethe University, Germany.,German Center for Cardiovascular Research, Frankfurt, Germany (L.N., W.T.A., S.D.).,Cardio-Pulmonary Institute, Frankfurt, Germany (L.N., W.T.A., S.D.)
| | - Wesley T Abplanalp
- Institute for Cardiovascular Regeneration (L.N., W.T.A., D.J., H.M., L.T., S.D.), Goethe University, Germany.,German Center for Cardiovascular Research, Frankfurt, Germany (L.N., W.T.A., S.D.).,Cardio-Pulmonary Institute, Frankfurt, Germany (L.N., W.T.A., S.D.)
| | - Anne Schänzer
- Institute of Neuropathology (A.S., M.K.), University Hospital Giessen, Justus Liebig Universität, Germany
| | - Anke Sprengel
- Pediatric Heart Center, Department of Pediatric Cardiac Surgery (A.S., H.A.), University Hospital Giessen, Justus Liebig Universität, Germany
| | - David John
- Institute for Cardiovascular Regeneration (L.N., W.T.A., D.J., H.M., L.T., S.D.), Goethe University, Germany
| | - Hannah Mellentin
- Institute for Cardiovascular Regeneration (L.N., W.T.A., D.J., H.M., L.T., S.D.), Goethe University, Germany
| | - Lukas Tombor
- Institute for Cardiovascular Regeneration (L.N., W.T.A., D.J., H.M., L.T., S.D.), Goethe University, Germany
| | - Matthias Keuper
- Institute of Neuropathology (A.S., M.K.), University Hospital Giessen, Justus Liebig Universität, Germany
| | - Evelyn Ullrich
- Experimental Immunology, Division of Pediatric Stem Cell Transplantation and Immunology, Children and Adolescents Medicine, University Hospital Frankfurt (E.U.), Goethe University, Germany.,Frankfurt Cancer Institute (E.U.), Goethe University, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Germany (K.K.)
| | | | - Jedrzej Hoffmann
- Internal Medicine Clinic III, Department of Cardiology (J.H., A.M.Z.), Goethe University, Germany
| | - Hakan Akintuerk
- Pediatric Heart Center, Department of Pediatric Cardiac Surgery (A.S., H.A.), University Hospital Giessen, Justus Liebig Universität, Germany
| | - Christian Jux
- Department of Pediatric Cardiology and Congenital Heart Disease (C.J., D.S., S.R.), University Hospital Giessen, Justus Liebig Universität, Germany
| | - Dietmar Schranz
- Department of Pediatric Cardiology and Congenital Heart Disease (C.J., D.S., S.R.), University Hospital Giessen, Justus Liebig Universität, Germany
| | - Andreas M Zeiher
- Internal Medicine Clinic III, Department of Cardiology (J.H., A.M.Z.), Goethe University, Germany
| | - Stefan Rupp
- Department of Pediatric Cardiology and Congenital Heart Disease (C.J., D.S., S.R.), University Hospital Giessen, Justus Liebig Universität, Germany
| | - Stefanie Dimmeler
- Institute for Cardiovascular Regeneration (L.N., W.T.A., D.J., H.M., L.T., S.D.), Goethe University, Germany.,German Center for Cardiovascular Research, Frankfurt, Germany (L.N., W.T.A., S.D.).,Cardio-Pulmonary Institute, Frankfurt, Germany (L.N., W.T.A., S.D.)
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Liu H, Zhang CH, Ammanamanchi N, Suresh S, Lewarchik C, Rao K, Uys GM, Han L, Abrial M, Yimlamai D, Ganapathy B, Guillermier C, Chen N, Khaladkar M, Spaethling J, Eberwine JH, Kim J, Walsh S, Choudhury S, Little K, Francis K, Sharma M, Viegas M, Bais A, Kostka D, Ding J, Bar-Joseph Z, Wu Y, Yechoor V, Moulik M, Johnson J, Weinberg J, Reyes-Múgica M, Steinhauser ML, Kühn B. Control of cytokinesis by β-adrenergic receptors indicates an approach for regulating cardiomyocyte endowment. Sci Transl Med 2020; 11:11/513/eaaw6419. [PMID: 31597755 PMCID: PMC8132604 DOI: 10.1126/scitranslmed.aaw6419] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/10/2019] [Accepted: 08/30/2019] [Indexed: 12/28/2022]
Abstract
One million patients with congenital heart disease (CHD) live in the United States. They have a lifelong risk of developing heart failure. Current concepts do not sufficiently address mechanisms of heart failure development specifically for these patients. Here, analysis of heart tissue from an infant with tetralogy of Fallot with pulmonary stenosis (ToF/PS) labeled with isotope-tagged thymidine demonstrated that cardiomyocyte cytokinesis failure is increased in this common form of CHD. We used single-cell transcriptional profiling to discover that the underlying mechanism of cytokinesis failure is repression of the cytokinesis gene ECT2, downstream of β-adrenergic receptors (β-ARs). Inactivation of the β-AR genes and administration of the β-blocker propranolol increased cardiomyocyte division in neonatal mice, which increased the number of cardiomyocytes (endowment) and conferred benefit after myocardial infarction in adults. Propranolol enabled the division of ToF/PS cardiomyocytes in vitro. These results suggest that β-blockers could be evaluated for increasing cardiomyocyte division in patients with ToF/PS and other types of CHD.
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Affiliation(s)
- Honghai Liu
- Richard King Mellon Foundation Institute for Pediatric Research and Division of Cardiology, UPMC Children's Hospital of Pittsburgh and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Cheng-Hai Zhang
- Department of Cardiology, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Niyatie Ammanamanchi
- Richard King Mellon Foundation Institute for Pediatric Research and Division of Cardiology, UPMC Children's Hospital of Pittsburgh and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Sangita Suresh
- Department of Cardiology, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Christopher Lewarchik
- Richard King Mellon Foundation Institute for Pediatric Research and Division of Cardiology, UPMC Children's Hospital of Pittsburgh and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Krithika Rao
- Richard King Mellon Foundation Institute for Pediatric Research and Division of Cardiology, UPMC Children's Hospital of Pittsburgh and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Gerrida M Uys
- Department of Cardiology, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Lu Han
- Richard King Mellon Foundation Institute for Pediatric Research and Division of Cardiology, UPMC Children's Hospital of Pittsburgh and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Maryline Abrial
- Department of Cardiology, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Dean Yimlamai
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Balakrishnan Ganapathy
- Richard King Mellon Foundation Institute for Pediatric Research and Division of Cardiology, UPMC Children's Hospital of Pittsburgh and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Christelle Guillermier
- Division of Genetics and Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Nathalie Chen
- Richard King Mellon Foundation Institute for Pediatric Research and Division of Cardiology, UPMC Children's Hospital of Pittsburgh and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Mugdha Khaladkar
- Department of Biology, School of Arts and Sciences, University of Pennsylvania, 301A/B Lynch Laboratory, 433 S University Avenue, Philadelphia, PA 19104, USA
| | - Jennifer Spaethling
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - James H Eberwine
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Junhyong Kim
- Department of Biology, School of Arts and Sciences, University of Pennsylvania, 301A/B Lynch Laboratory, 433 S University Avenue, Philadelphia, PA 19104, USA
| | - Stuart Walsh
- Department of Cardiology, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Sangita Choudhury
- Department of Cardiology, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Kathryn Little
- Richard King Mellon Foundation Institute for Pediatric Research and Division of Cardiology, UPMC Children's Hospital of Pittsburgh and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Kimberly Francis
- Richard King Mellon Foundation Institute for Pediatric Research and Division of Cardiology, UPMC Children's Hospital of Pittsburgh and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Mahesh Sharma
- Division of Cardiothoracic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Melita Viegas
- Pediatric Cardiothoracic Surgery, UPMC Children's Hospital of Pittsburgh and Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Abha Bais
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15201, USA
| | - Dennis Kostka
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15201, USA.,Department of Computational & Systems Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.,Pittsburgh Center for Evolutionary Biology and Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Jun Ding
- Computational Biology Department and Machine Learning Department, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Ziv Bar-Joseph
- Computational Biology Department and Machine Learning Department, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Yijen Wu
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15201, USA.,Rangos Research Center Animal Imaging Core, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Vijay Yechoor
- Diabetes and Beta Cell Biology Center, Division of Endocrinology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15238, USA
| | - Mousumi Moulik
- Division of Cardiology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Jennifer Johnson
- Division of Cardiology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA.,Neonatal-Perinatal Medicine, UPMC Magee-Womens Hospital, Pittsburgh, PA 15213, USA
| | - Jacqueline Weinberg
- Division of Cardiology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Miguel Reyes-Múgica
- Division of Pediatric Pathology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Matthew L Steinhauser
- Division of Genetics and Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Bernhard Kühn
- Richard King Mellon Foundation Institute for Pediatric Research and Division of Cardiology, UPMC Children's Hospital of Pittsburgh and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA 15224, USA. .,McGowan Institute of Regenerative Medicine, Pittsburgh, PA 15219, USA.,Pediatric Institute for Heart Regeneration and Therapeutics, Pittsburgh, PA 15224, USA
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5
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Jiang X, Sucharov J, Stauffer BL, Miyamoto SD, Sucharov CC. Exosomes from pediatric dilated cardiomyopathy patients modulate a pathological response in cardiomyocytes. Am J Physiol Heart Circ Physiol 2017; 312:H818-H826. [PMID: 28130338 DOI: 10.1152/ajpheart.00673.2016] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/19/2017] [Accepted: 01/20/2017] [Indexed: 11/22/2022]
Abstract
Stimulation of the renin-angiotensin-aldosterone system (RAAS) and β-adrenergic receptors plays an important role in adult heart failure (HF). Despite the demonstrated benefits of RAAS inhibition and β-adrenergic receptor blockade in adult HF patients, no substantial improvement in survival rate has been observed in children with HF. This suggests that the underlying disease mechanism is uniquely regulated in pediatric HF. Here, we show that treatment of human-induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) and neonatal rat ventricular myocytes (NRVMs) with serum from pediatric dilated cardiomyopathy (DCM) patients induces pathological changes in gene expression, which occur independently of the RAAS and adrenergic systems, suggesting that serum circulating factors play an important role in cardiac remodeling. Furthermore, exosomes purified from DCM serum induced pathological changes in gene expression in NRVMs and iPSC-CMs. Our results suggest that DCM serum exosomes mediate pathological responses in cardiomyocytes and may propagate the pediatric HF disease process, representing a potential novel therapeutic target specific to this population.NEW & NOTEWORTHY The results of this work could alter the present paradigm of basing clinical pediatric heart failure (HF) treatment on outcomes of adult HF clinical trials. The use of serum-treated primary cardiomyocytes may define age-specific mechanisms in pediatric HF with the potential to identify unique age-appropriate and disease-specific therapy.
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Affiliation(s)
- Xuan Jiang
- Division of Cardiology, Department of Medicine, University of Colorado Denver, Aurora, Colorado
| | - Juliana Sucharov
- Division of Cardiology, Department of Medicine, University of Colorado Denver, Aurora, Colorado.,University of Colorado Boulder, Boulder, Colorado
| | - Brian L Stauffer
- Division of Cardiology, Department of Medicine, University of Colorado Denver, Aurora, Colorado.,Division of Cardiology, Department of Medicine, Denver Health and Hospital Authority, Denver, Colorado; and
| | - Shelley D Miyamoto
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital, Aurora, Colorado
| | - Carmen C Sucharov
- Division of Cardiology, Department of Medicine, University of Colorado Denver, Aurora, Colorado;
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